Management of Protective Equipment

Collision sports, such as football and ice hockey, further complicate the risk of cervical spine injury because of the protective equipment associated with each athlete. Helmets and shoulder pads aim to protect athletes from contact, but they often provide little additional support for motion of the spine and, quite frankly, make it difficult to assess the patient completely.

In 1998, the National Athletic Trainers’ Association (NATA) formed the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete to develop guidelines for the proper management of the athlete with a catastrophic spine injury.

Unlike motorcycle helmets, which limit force distribution for impact, most recent designs for football and ice hockey helmets work with the shoulder pads to prevent excessive motion of the spine. Although this topic has been the subject of much debate historically, these recent advances in design recognize the importance of keeping protective equipment on during the initial evaluation.

This increased, if limited, stability of the cervical spine in neutral position is more important than full exposure, because even small amounts of abnormal motion during a suspected cervical spine injury may cause damage.

Numerous cadaveric and human studies were used to formulate a consensus, and formal regulations are now in place. Basic science studies support the idea that helmets and pads give support and alignment to the injured cervical spine.

In the study by Palumbo et al.The removal of the helmet or the shoulder pads from a cadaveric model significantly changed the cervical lordosis in a spine with C5-C6 instability. Clinically, LaPrade et al.

It again demonstrated by computed tomography (CT) that removal of the helmet or the shoulder pads in ice hockey players resulted in a significant increase in cervical spine extension (lordosis). Furthermore, Waninger et al.It demonstrated that during transport and backboard-immobilization, an athlete’s helmet effectively limits cervical motion.

Understandably, leaving protective equipment in place is not possible in all scenarios. The safety of the athlete may, in fact, rely on removal of the helmet or shoulder pads. Specific protocols have been developed by theInter-Association Task Force for Appropriate Care of the Spine-Injured Athlete to emphasize the importance of using multiple care providers for equipment removal. Donaldson et al.

It used cadaver models to measure motion and technique during helmet removal of specimens with C1-C2 instability. Their study, along with the advent of digital fluoroscopy, helped to establish a more accepted protocol of using four providers, as recommended by NATA, that limits cervical motion.